Hi. I have two food-allergy related questions.
One, is there any evidence (as in clinical work) anyone can point me to that an allergic reaction to food can occur more than a few hours after ingesting the food?

Two, does anyone know of a place where I could read about sugar allergy. I doubt such a thing is possible, but I'm looking for something in a book or article by a board certified allergist perhaps, or just a regular MD on why a sugar allergy could or could not be possible.

Well, perhaps this might answer both your questions. First of all, yes you can have allergic reactions to sugar. There is such a thing called sucrose intolerance and this usually is related to celiac sprue disease. Since celiac allergies are allergies to gluten, it makes sense that a sugar sensitivity would go hand in hand. Gluten broken down, is after all, sugar (glucose).

The answer to your other question about delay in response time is, yes it is possible to have an allergic reaction after a delay. The difference is the degree of allergic response.

When you ingest a food that you have a allergy to, there are is an immediate immmune response that produces IgE antibodies and a delayed T-cell response. The severity of your bodies reaction to the allergen (the offending food) determines whether or not your body goes into anaphylactic shock. When this happens, your body overresponds to the allergen and the antibodies in your blood rush to the affected area (in this case, your throat and surrounding areas). When this happens, your bronchial tubes become engorged with blood and they constrict. This cuts off your air supply and you in essence, choke to death. Because allergic reactions are so severe this effect can happen in minutes.

This past year a girl in Canada who was severly allergic to peanuts kissed her boyfriend, who had eaten a peanut butter and jelly sandwich about an hour before. She promptly dropped dead in minutes. But how did she die if she wasn't the one eating the offending food? Nuts have oils and other allergic foods, such as shellfish have juices on the flesh that can cause the same allergic reactions. Cross contamination is a HUGE issue with this. Another man in an Italian restaurant, I believe here in NJ, died within a few minutes after eating a couple bites of a pasta dish. This man was allergic to shellfish. The dish he was ordering normally had shrimp in it. Even though he made it clear to the server that he had an allergy, the cook forgot. Instead of remaking the dish, he simply picked out the shrimp...and tragedy ensued. Individuals who are this allergic to a certain food should never, EVER be without an epi pen. While an epi pen is not a cure for an allergic reaction (use of an epi pen should always be followed up with a hospital visit) it can allow time for a medical response team to arrive, or enough time to get the victim to a nearby hospital.

On the other hand, when you have a food sensitivity (known as a food intolerance) it is not viewed as an allergy per se, because the response is not as severe. Depending on the amount of allergen you consume determines the rate of reaction. Usually when someone with this kind of intolerance does not have the proper enzymes to break down food properly, have bad reactions to natural chemicals found in food or to artificial preservatives (such as sodium nitrate-found in deli meats), flavors (arificial vanilla flavoring), sweetners (aspartame), and colors (yellow #5). People with this kind of response have a delay in response from T-cells, so this would account for not having the immediate allergy response. Hope this helped!

Correct you are, there is no immune response. Perhaps I wasn't clear on that. But speaking from a hospitality perspective, most guest claims of food intolerance are still treated as an allergy in our restaurant. We have no idea how much of the food in question they are able to eat before it causes negative reactions in their body, and specifically what those reactions would be, because every person's body is different. This is why we inform them as much as possible about cooking and handling procedures, and have the food brought out by a manager. We allow the guest to decide for themselves whether or not they want to eat that item. This way, we have covered all of our bases in the event of a possible lawsuit. In cases where an error in judgement on my part might cause harm to one of my guests, I prefer to err on the side of caution.

Thanks for your answers.... but do you know of anywhere I can read about clinical studies of these things? Because there are so many contradictory claims out there, what I want to be able to do is look at research and decide for myself what is possible, what is likely, etc.
The reason is that I'm seeing a fair amount of food allergy self-diagnosis in people with very active imaginations and the correlation between what they've eaten and the symptoms is often arbitrary and speculative.
In some cases, they believe that their allergies require them to abstain from wheat for a few days "because I've been eating alot of that lately" and some symptoms are appearing (eczema, etc.) or they'll say, "no bananas today, I'm having enough trouble as it is and I've been eating those every day for a while" etc.
My instincts tell me this is wild speculation and nothing more, especially when the supposed allergic response is days after the supposed offending food and the offending food is constantly changing.
So I'm looking for double blind clinical work to help me decide whether I should take it more seriously... or just some really good books by allergists.
Unfortunately, the books I'm finding so far are all introductory in nature and telling me what I already know.

ladykat324 wrote:Well, perhaps this might answer both your questions. First of all, yes you can have allergic reactions to sugar. There is such a thing called sucrose intolerance and this usually is related to celiac sprue disease. Since celiac allergies are allergies to gluten, it makes sense that a sugar sensitivity would go hand in hand. Gluten broken down, is after all, sugar (glucose).

that's wrong...

firstly, gluten is a protein made up of amino acids - not glucose...!

secondly. 'sucrose intolerance' is not an allergy - it's an intolerance due to lack of sucrase and it has no connection to coeliac disease whatsoever...

aharown07 wrote:Thanks for your answers.... but do you know of anywhere I can read about clinical studies of these things?

try the cochraine library... it's online...

Many thanks. Looks like a gold mine (looks like it's Cochrane though).

I've also noticed allergists in various places making a distinction between IgE mediated reactions and non-IgE mediated ones. Some seem to suggest that non-IgE might still be a form of allergy. Others, are quite clear that they do not consider non-IgE hypersensitivity to be allergic.
On that topic, if it isn't allergy, what can we call it? "Intolerance" maybe? Or just Type IV Hypersensitivity?

As far as you know, do non-IgE reactions ever produce the typical allergic symtpoms such as allergic rhinitis, urticaria, watering eyes and what not?
And does it ever produce anaphylaxis?

aharown07 wrote:I've also noticed allergists in various places making a distinction between IgE mediated reactions and non-IgE mediated ones. Some seem to suggest that non-IgE might still be a form of allergy. Others, are quite clear that they do not consider non-IgE hypersensitivity to be allergic.On that topic, if it isn't allergy, what can we call it? "Intolerance" maybe? Or just Type IV Hypersensitivity?

As far as you know, do non-IgE reactions ever produce the typical allergic symtpoms such as allergic rhinitis, urticaria, watering eyes and what not?And does it ever produce anaphylaxis?

i know 'allergy' as only being type I hypersensitivity and only IgE mediated...

what 'non-IgE mediated allergies' are you talking about?

type IV hypersensitivities aren't 'allergies'... the symptoms of type IV hypersensitivities aren't similar e.g. coeliac disease and rheumtoid arthritis are both cell-mediated hypersensitivities but their symptoms are completely different (but neither has 'allergic' syptoms)

'intolerance' is not autoimmunity... it is due to having limited amounts of an enzyme... e.g. 'lactose intolerance' is due to limited amounts of the enzyme 'lactase'... so the body has limited ability to break down lactose...

Revenged wrote:i know 'allergy' as only being type I hypersensitivity and only IgE mediated...

what 'non-IgE mediated allergies' are you talking about?

type IV hypersensitivities aren't 'allergies'... the symptoms of type IV hypersensitivities aren't similar e.g. coeliac disease and rheumtoid arthritis are both cell-mediated hypersensitivities but their symptoms are completely different (but neither has 'allergic' syptoms)

'intolerance' is not autoimmunity... it is due to having limited amounts of an enzyme... e.g. 'lactose intolerance' is due to limited amounts of the enzyme 'lactase'... so the body has limited ability to break down lactose...

I've done some more reading and see the problem. Some of the research is being done from a "start with the symptoms" approach (e.g., Hugh Sampson's work on eczema), and thus, they aren't particularly interested in whether it's "allergy" or not. They tend to move from allergic reactions to other sorts of reactions and back again. Especially where ezema is involved, many seem to link it to type IV hypersensitivity, focusing on T cells.
So here's the question, if eczema isn't really "allergy" (IgE stuff) but isn't "intolerance" (enzyme deficiency), what is it?
I'm guessing that until the cause is fully understood it's just "a skin disease that is apparently sometimes due to type iv hypersensitivity"?

It's complicated though. There are lots of correlations between between eczema and regular IgE allergic responses to pollen, dust mites and foods.
I'm guessing there just isn't enough known yet to really give this sort of problem a "category."

aharown07 wrote:I've done some more reading and see the problem. Some of the research is being done from a "start with the symptoms" approach (e.g., Hugh Sampson's work on eczema), and thus, they aren't particularly interested in whether it's "allergy" or not. They tend to move from allergic reactions to other sorts of reactions and back again. Especially where ezema is involved, many seem to link it to type IV hypersensitivity, focusing on T cells.So here's the question, if eczema isn't really "allergy" (IgE stuff) but isn't "intolerance" (enzyme deficiency), what is it?I'm guessing that until the cause is fully understood it's just "a skin disease that is apparently sometimes due to type iv hypersensitivity"?

It's complicated though. There are lots of correlations between between eczema and regular IgE allergic responses to pollen, dust mites and foods.I'm guessing there just isn't enough known yet to really give this sort of problem a "category."

I'm not sure about eczema... There are many different types of eczema but I dont really know how it happpens...

I have found that people use 'allergy' very loosely... I only take notice of sensible allergies e.g. to pollen, asthma, peanut allergy, shellfish... but I don't believe half the people I've seen at GP genuinely suffer from allergies... I have seen bizarre allergies to E numbers, to bizzare animals and bizzare foods - one of the marks of the hypochondriacs !...

Don't know if anyone's still watching this but...
A related followup question to my original post.

How long does an ingested protein remain in the body before being broken down into something no longer traceable to that protein? I'm sure some take longer than others to be metabolized (or whatever the right term is).
For example, if someone claims to be allergic to milk, that would pretty much mean milk proteins (the sugar, lactose, could produce an intolerance if the person lacks lactase, but not an allergy).

So is it possible, as this person claims, that milk proteins from a variety of foods could build up over a period of several days (or even weeks) and very slowly produce an allergic reaction, only when an unknown threshold is reached?

Being naturally skeptical, I'm inclined to think that casienate, for example, turns into something no longer unique to milk within a fairly short time after being eaten... hence, a build up of casienate anywhere in the body is unlikely.

Am I on the right track? Does the digestive system turn these unique proteins into smaller peptide chains or amino acids fairly quickly? Or do they go to cells more or less "whole" or what?